INTRODUCTION TO RESPIRATORY THERAPY

2ND SEMESTER: MIDTERM

RESPIRATORY THERAPISTS
Elements of A Hospital-Based • In addition to capable medical direction and the
Respiratory Care Program: application of well-constructed respiratory care
Roles Supporting Quality Care protocols, capable RTs are an indispensable
element of a quality respiratory care program.
Medical Direction • The quality of RTs depends primarily on their
• The medical director of respiratory care is training, education, experience, and professionalism.
professionally responsible for the clinical function of • Training teaches students to perform tasks at a
the department and provides oversight of the clinical competent level, whereas clinical education provides
care that is delivered. students with a knowledge base they can use in
• Medical direction for respiratory care is usually evaluating a situation and making appropriate
provided by a pulmonary/critical care physician or an decisions.
anesthesiologist. Whether the role of a respiratory • Both adequate training and clinical education are
care service medical director is designated as a required to produce qualified RTs for assessment of
full-time or part-time position, it is a full-time patients and implementation of respiratory care
responsibility. protocols.
• The medical director must be available on a 24-
hour basis for consultation with and to give advice to Designations and Credentials of Respiratory
other physicians and the respiratory care staff. Therapists (PH Context)
• The current philosophy of cost containment and • There is only one level of general practice
cost-effectiveness, dictated by medical care market credentialing in respiratory care:
forces, poses a challenge to the medical and • Passed the licensure examination for Respiratory
technical leadership of respiratory care services to Therapist under the Board of Respiratory Therapy of
provide increasingly high-quality patient care at low Professional Regulatory Commission.
cost. A medical director must possess administrative • Students eligible to become RTRP are trained and
and medical skills. educated in colleges and universities.
• After completion of an approved respiratory care
Medical supervision of RTs in the following areas educational program, a graduate may become
• General medical, surgical, and respiratory nursing eligible to sit for the registry examinations to become
wards a credentialed RTRP (students who complete a 4-
• ICUs year program receive a baccalaureate degree.)
• Ambulatory care (including rehabilitation) • Some RTs go on to complete a graduate degree
• Pulmonary function laboratory (e.g., master or doctorate) with additional study in
• Development and approval of department clinical the areas of respiratory care, education,
policies and procedures management, or health sciences.
• Supervision of ongoing quality assurance activities • Credentialing is a general term that refers to the
• Medical direction for respiratory care in-service and recognition of individuals in particular occupations or
training programs professions. Generally, the two major forms of
• Education of medical and nursing staffs regarding credentialing in the health fields are state licensure
respiratory therapy and voluntary certification.
• Participation in the selection and promotion of • Licensure is the process in which a government
technical staff agency gives an individual permission to practice an
• Participation in the preparation of the department occupation. Typically, a license is granted only
budget after verifying that the applicant has demonstrated
the minimum competency necessary to protect the
Medical Direction public health, safety, or welfare. Licensure laws are
• Perhaps the most essential aspect of providing normally made by state legislatures and enforced by
quality respiratory care is to ensure that the care specific state agencies, such as medical, nursing,
being provided is indicated and that it is delivered and respiratory care boards. In states where
competently and appropriately. licensure laws govern an occupation, practicing in
• Traditionally, the physician has evaluated patients the field without a license is considered a crime
for respiratory care and has written the specific punishable by fines or imprisonment or both.
respiratory therapy orders for the respiratory • Licensure regulations are based on a practice act
therapist (RT) to follow. that defines (and limits) what activities the
• However, such traditional practices have often professional can perform.
been shown to be associated with misallocation of • Two other forms of state credentialing are less
respiratory care. restrictive.
 INTRODUCTION TO RESPIRATORY THERAPY
2ND SEMESTER: MIDTERM
• States that use title protection simply safeguard the
use of a particular occupational or professional title.
Alternatively, states may request or require
practitioners to register with a government agency
(registration). Neither title protection nor state
registration constitutes a true practice act, and
because both title protection and registration are
voluntary, neither provides strong protection against
unqualified or incompetent practice.
Additional Respiratory Therapist Skills Required
for Implementing Protocols
• Assess and evaluate patients regarding indications
for therapy and for the most appropriate delivery
method
• Be cognizant of age-related issues and how they
affect the patient’s ability to understand and use
various treatment modalities
• Adapt hospital policies and procedures to
alternative care sites
• Conduct and participate in research activities to
ensure a scientific basis for advances in respiratory
care technology
• Communicate effectively with all members of the
health care team, and contribute to the body of
literature concerning the field of respiratory care
PROFESSIONALISM
• By definition, professionalism is a key attribute to
which all RTs should aspire and that must guide
respiratory care practice.
• Webster’s New Collegiate Dictionary defines a
profession as “a calling that requires specialized
knowledge and often long and intensive academic
preparation.”
• A professional is characterized as an individual
conforming to the technical and ethical standards of
a profession. RTs demonstrate their professionalism
by maintaining the highest practice standards, by
engaging in ongoing learning, by conducting
research to advance the quality of respiratory care,
and by participating in organized activities through
professional societies such as the AARC and
associated state societies.
• Emphasize the importance of these attributes
because the continued value and progress of the
field depend critically on the professionalism of each
practitioner.
Professional Characteristics of a Respiratory
Therapist
• Completes an accredited respiratory therapy
program
• Obtains professional credentials
• Participates in continuing education activities
• Adheres to the code of ethics put forth by the
institution or state licensing board or both
• Joins professional organizations
TECHNICAL DIRECTION
• Another important element for delivering quality
respiratory care is technical direction.
• Technical direction is often the responsibility of the
manager of a respiratory care department, who must
ensure the equipment and the associated protocols
and procedures have sufficient quality to ensure the
safety, health, and welfare of the patient using the
equipment.
• Procedures and protocols related to the use of
equipment and medications must be written to
provide a guide for the respiratory care staff. In
addition, equipment must be safety checked, and
specific maintenance procedures must be performed
on a regular basis.
• Because of rapidly changing respiratory care
technology, the job of the technical director poses
significant challenges.
• Circuit boards and computers have replaced
simpler mechanical devices. New medications and
delivery devices for the treatment of asthma and
new strategies for treating other respiratory diseases
(e.g., low-stretch ventilatory approaches for acute
respiratory distress syndrome [ARDS]) continue to
evolve.
• Individuals responsible for technical direction must
ensure that these new devices, methods, and
strategies not only are effective but also deliver a
benefit commensurate with the cost.
METHODS FOR ENHANCING QUALITY
RESPIRATORY CARE
Respiratory Care Protocols
• In an effort to improve the allocation of respiratory
care services, respiratory care protocols (also known
as therapist-driven protocols.
• Put in a place to enhance appropriate allocation of
respiratory care services.
• Represent guidelines to deliver care only when
indicated, by correct method; discontinued when no
longer needed.
Key Elements of a Respiratory Care Protocol
Program
• Strong and committed medical direction
• Capable therapist
• active quality monitoring
• Collaborative environment among RTs, physicians,
and nurses
• Responsiveness of all participants to address and
correct problems
Sequence of Events for a Respiratory Care
Consult
• A physician writes an order for a respiratory care
protocol or consult.
• The nursing unit secretary notifies an RT evaluator.
 INTRODUCTION TO RESPIRATORY THERAPY
2ND SEMESTER: MIDTERM

• The evaluator assesses the patient using specific

guidelines.
• The evaluator writes a care plan using designated
indications and algorithms and documents care plan
in the patient's chart for review by the physician.
• The RT covering the nursing unit delivers the care.
• The patient is assessed on a shift-by-shift basis for
change in status and indicated modifications for the
care plan, which are also documented.
• The physician is notified of any deterioration in the
patient’s status.
• When indications for respiratory care no longer
exist, respiratory care treatment is discontinued and
notification is placed in the patient’s chart.

CODE OF ETHICS
• Demonstrate behavior that reflects integrity,
supports objectivity, and fosters trust in the
profession and its professionals.
• Promote and practice evidence-based medicine.
• Seek continuing education opportunities to improve
and maintain their professional competence and
document their participation accurately.
• Perform only those procedures or functions in
which they are individually competent, and which are
within their scope of accepted and responsible
practice.
• Respect and protect the legal and personal rights
of patients, including the right to privacy, informed
consent, and refusal of treatment.
• Divulge no protected information regarding any
patient or family unless disclosure is required for the
responsible performance of duty as authorized by
the patient and/or family or required by law.
• Provide care without discrimination on any basis,
with respect for the rights and dignity of all
individuals.
• Promote disease prevention and wellness.
• Refuse to participate in illegal or unethical acts.
• Refuse to conceal, and will report, the illegal,
unethical, fraudulent, or incompetent acts of others.
• Follow sound scientific procedures and ethical
principles in research.
• Comply with state or federal laws which govern
and relate to their practice.
• Avoid any form of conduct that is fraudulent or
creates a conflict of interest and shall follow the
principles of ethical business behavior.
• Promote health care delivery through improvement
of the access, efficacy, and cost of patient care.
• Encourage and promote appropriate stewardship
of resources.